Older Adults and Their Families: An Interactional Intervention That Brings Forth Love and Softens Suffering.

When assisting older adults and their families, the most useful family nursing conceptual skill is embracing the belief that "illness is a family affair." This illness belief summons a systemic or interactional focus specifically on relationship communication patterns. Uncovering maladaptive and distressing familial interactions, a family nurse can intervene and offer ideas for more loving and caring interactional patterns. Three brief and one detailed clinical case example, illustrating how to conceptualize interactional patterns and how to intervene, are offered. This article also presents the author's firsthand caregiving experience with its accompanying joys and pitfalls. Despite her decades of clinical practice and professional assistance to numerous elderly families, the caregiving and interactions with her father held no guarantee of being filled with consistent care and love. Although not easily applicable to one's own family, focusing on the interrelationships with the elderly and their families, the embedded interactional patterns become the crucial ingredient to facilitate more satisfying and loving relationships.

Application of the Calgary Family Assessment and Intervention Models: Reflections on the Reciprocity Between the Personal and the Professional.

Much has been written about the global implementation of the Calgary Family Assessment and Intervention Models (CFAM/CFIM) and the application of these practice models in various clinical settings. The purpose of this article is to provide a brief update on the background of CFAM/CFIM, and the current applications of the models as evidenced in the English-language literature. Little has been written about the use of CFAM/CFIM in a personal context, however. As originators of the models, we offer our own narratives and reflections about the reciprocity between the personal and professional applications of our models and the ways that our personal experiences have extended our understanding about the utility of the models for clinical practice with families.

Brain science and illness beliefs: an unexpected explanation of the healing power of therapeutic conversations and the family interventions that matter.

Paradigm families and paradigm practice moments have shown me that therapeutic conversations between nurses and families can profoundly and positively change illness beliefs in family members and nurses and contribute to healing from serious illness. The integration of brain science into nursing practice offers further understanding of the importance of illness beliefs and the role they may play in helping individual and family healing. Brain science offers explanations that connect how certain family nursing interventions that soften suffering and challenge constraining illness beliefs may result in changes in brain structure and functioning. New illness beliefs may result in new neural pathways in the brain, and therefore, possibilities for a new way of being in relationship with illness and in relationship with others can also develop. Newly acquired practice skills and interventions that have emerged from an understanding of brain science plus the reemphasis of other interventions utilized in the Illness Beliefs Model are offered to enhance our care of families suffering with illness.

What are the benefits of a short therapeutic conversation intervention with acute psychiatric patients and their families? A controlled before and after study.

BACKGROUND: Psychiatric illness of a family member can have a serious impact on the entire family. In addition, these families are faced with psychological burdens and stigmas. Little is known about the effectiveness of family nursing interventions on patients and their families when a family member is admitted for psychiatric treatment. Few studies have been published where family nursing interventions are integrated into routine inpatient services. PURPOSE: To evaluate the effectiveness of implementing a therapeutic conversation intervention in acute inpatient psychiatry with families, by evaluating family perceived support, expressive family function and general well-being. DESIGN AND METHODS: A controlled before and after study design was used. Patients and family members at four acute psychiatric units at a university hospital were selected for the implementation of family systems nursing (FSN). The nurses on one acute psychiatric unit were educated, trained, and supervised in a therapeutic conversation intervention built on the Calgary Family Assessment and Interventions models (Wright and Leahey, 2009). In the intervention group, 68 patients and 68 family members (N=136), received two-to-five therapeutic conversations with a nurse. The control groups were from three other acute units at the hospital, where 74 patients and 74 family members (N=148) received family nursing care as usual. RESULTS: The main findings indicated that family members who received the short therapeutic conversation intervention were found to perceive significant higher cognitive and emotional support from the nurses than family members who received standard care. CONCLUSION: The benefits of a specific short-term therapeutic conversation intervention are evident and valuable for nurses working in acute psychiatry. These positive results for families of psychiatric patients should not only encourage and propel clinical educators, clinical nurses and nurse researchers and other health professionals to develop and implement the therapeutic conversation intervention in acute psychiatric services but also be part of ritualized protocols of practice.

Therapeutic letters and the family nursing unit: a legacy of advanced nursing practice.

This article focuses on the history of the use of therapeutic letters in the clinical scholarship of the Family Nursing Unit at the University of Calgary and offers examples of a variety of therapeutic letters written to families experiencing illness suffering. A case study from the research of Moules (2000, 2002) is offered to further illustrate the usefulness of therapeutic letters as a family nursing intervention.

Living the as-yet unanswered: spiritual care practices in family systems nursing.

A serious illness often creates suffering and precipitates a search for spiritual meaning. The purpose of this hermeneutic inquiry was to explore the meaning of spirituality and spiritual care practices in family systems nursing. The videotapes of 12 therapeutic conversations with three families living with serious illness were the primary data for the inquiry. Findings suggest that suffering embodies an invitation to respond to the spiritual. Identified spiritual care practices included gathering stories of illness and faith, opening space to reinterpret experiences from a spiritual perspective, drawing on imagination and metaphor, and listening with an opening silence. The therapeutic work with one family is highlighted. This inquiry revealed that spiritual care requires literacy in reading the spiritual, a willingness to respond to the particular and the unpredictable, and a belief that good care demands a wise and thoughtful response to the suffering other.

Softening suffering through spiritual care practices: one possibility for healing families.

Nurses are engaged and encounter suffering routinely and commonly in their everyday practice. It is therefore a moral and ethical obligation for nurses to soften the emotional, physical, and spiritual suffering of the individuals and families in their care. Softening suffering is the heart of nursing. However, this article ponders the question, "What happened to suffering in nursing care?" A discussion of suffering is explored from many aspects, such as what invites suffering and the connection of suffering to spirituality. Lessons learned from the author's clinical practice and research are described, such as acknowledging suffering, social support, hope and prayer, and individual and family counseling. Finally, seven spiritual care practices within the Trinity Model that have shown to be useful in softening suffering are offered. An actual clinical example is woven throughout to illustrate the benefits of these spiritual care practices in the mission of softening illness suffering.

Exploring the therapeutic family intervention of commendations: insights from research.

Offered in this article are interpretations that emerged in a qualitative, interpretive study focused on the family intervention called a "commendation." The tradition of philosophical hermeneutics informs and shapes the analysis of the data. Research participants include a heterosexual couple and a nurse who engaged in therapeutic conversations focused on difficulties with Internet pornography. Data sources include videotapes of clinical sessions, documentation, and research interviews. Isolated segments of clinical videotape are shared with the couple to prompt their memory of commending practices that emerged in clinical sessions. Commendations are not experienced by this couple as gentle and warm but instead as extremely provocative, albeit constructive. This study illuminates the complex, contextual nature of commending practice and suggests that the noticing of strengths and resources contains much more than the spoken word.

The three most common errors in family nursing: how to avoid or sidestep.

In this article, the authors offer what they believe to be the three most common errors or mistakes in relational family nursing practice. Each error is described, followed by practical suggestions on how the mistake or error can be avoided. A clinical case vignette for each error is also given, with useful ideas of how the mistakes could have been avoided or sidestepped. By sidestepping and avoiding the most prevalent mistakes, nurses can not only sustain but also improve their nursing care of families and thus prevent unnecessary anguish and suffering of family members and possible shame, guilt, or embarrassment on the part of the nurse.